Can MS cause hair loss? It is a question many people living with multiple sclerosis ask, particularly when they notice unexpected shedding or thinning. MS itself — a chronic autoimmune condition affecting the central nervous system — does not directly cause hair loss, and it is not listed among the core symptoms recognised by the NHS. However, hair changes are commonly reported by people with MS, and understanding why requires looking at indirect factors: medication side effects, stress, nutritional deficiencies, and co-existing autoimmune conditions. This article explains the evidence clearly, in line with NICE and UK clinical guidance.

Does Multiple Sclerosis Directly Cause Hair Loss?

MS does not directly cause hair loss; demyelination does not affect hair follicles. Hair loss in people with MS is most likely indirect, arising from medication side effects, stress, nutritional deficiencies, or co-existing autoimmune conditions.

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Multiple sclerosis (MS) is a chronic autoimmune condition affecting the central nervous system, in which the immune system mistakenly attacks the myelin sheath surrounding nerve fibres. MS causes a wide range of neurological symptoms — including fatigue, muscle weakness, vision disturbances, and cognitive changes — but hair loss is not a recognised or direct symptom of the condition itself. The NHS lists the core symptoms of MS and does not include hair loss among them.

The demyelination and nerve damage that characterise MS do not directly affect hair follicles or the hair growth cycle. Importantly, hair loss is not a sign of MS relapse or disease progression. However, many people living with MS do report experiencing hair thinning or shedding at some point, which can understandably cause concern and distress.

Hair loss in people with MS is most likely indirect — meaning it arises from associated factors such as medication side effects, physiological or psychological stress, nutritional deficiencies, or co-existing conditions, rather than from MS itself. Because MS is an autoimmune condition, individuals have a higher likelihood of developing other autoimmune disorders; both autoimmune thyroid disease (such as Hashimoto's thyroiditis or Graves' disease) and alopecia areata are more prevalent in people with autoimmune conditions generally. It is also worth noting that certain disease-modifying therapies (DMTs) — particularly alemtuzumab — are known to increase the risk of secondary autoimmune conditions, including thyroid disease, as a recognised treatment-related effect. Recognising the indirect nature of hair loss in MS is essential for identifying the correct cause and pursuing appropriate management, in line with NICE guidance on MS care (NICE NG220).

MS Medications Linked to Hair Thinning and Shedding

Several DMTs, including interferon beta preparations and teriflunomide, list alopecia as a known adverse reaction. Hair thinning typically begins in the early months of treatment and is often self-limiting.

Several disease-modifying therapies (DMTs) used to treat MS are associated with hair thinning or shedding as a known adverse effect. Understanding this can help patients feel more informed and less alarmed. Always use the generic name of your medicine as the primary reference; brand names are given here for recognition only.

Interferon beta preparations — including interferon beta-1a (Avonex, Rebif) and interferon beta-1b (Betaferon, Extavia) — are commonly prescribed DMTs in the UK, approved by the MHRA and EMA. Alopecia is listed as an adverse reaction in the electronic Medicines Compendium (emc) summaries of product characteristics (SmPCs) for these medicines. The precise mechanism is not established, and patients should not assume a causal link without discussing their symptoms with their clinical team.

Teriflunomide (Aubagio), an oral DMT that works by inhibiting pyrimidine synthesis to reduce lymphocyte proliferation, lists alopecia as a common adverse reaction in its emc SmPC (occurring in 1 in 10 to 1 in 100 patients). Hair thinning typically occurs in the early months of treatment and is often self-limiting, resolving without the need to stop treatment.

Fingolimod (Gilenya) and cladribine (Mavenclad) have been associated with hair loss in some individuals; however, the frequency and nature of this association should be verified against the current emc SmPCs for these medicines, as reporting rates vary. If you experience hair changes after starting either of these treatments, discuss this with your MS nurse or neurologist.

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Azathioprine is an older immunosuppressant that can cause hair thinning. It is important to note that azathioprine is used off-label in MS and is not a NICE-recommended DMT for MS management (NICE NG220); its use is therefore uncommon in current UK practice.

Key points to be aware of:

• Hair loss linked to DMTs is usually diffuse (spread across the scalp) rather than patchy

• It often begins within the first few months of starting a new medication

• In many cases, shedding stabilises or improves as the body adjusts

• Never stop a prescribed DMT without first consulting your neurologist or MS nurse, as this can have serious implications for disease control

• If you believe a medicine is causing a side effect, you can report this to the MHRA via the Yellow Card Scheme (yellowcard.mhra.gov.uk)

Other Factors That May Contribute to Hair Loss in MS

Telogen effluvium triggered by stress or illness, iron or ferritin deficiency, and co-existing autoimmune conditions such as thyroid disease or alopecia areata are the most clinically relevant indirect causes of hair loss in MS.

Beyond medication side effects, several other factors commonly experienced by people with MS may contribute to hair loss, and it is worth considering these holistically.

Telogen effluvium is one of the most common causes of diffuse hair shedding. It occurs when physiological or psychological stress pushes a large number of hair follicles into the resting (telogen) phase simultaneously. Receiving an MS diagnosis, experiencing a relapse, undergoing surgery, or managing the ongoing demands of chronic illness can all act as triggers. Hair loss from telogen effluvium typically begins two to three months after the triggering event and is usually temporary, as described in British Association of Dermatologists (BAD) patient information.

Nutritional deficiencies are also relevant. Fatigue and mobility difficulties associated with MS can affect appetite, dietary variety, and the ability to prepare balanced meals. Deficiencies in iron and ferritin are well-established contributors to diffuse hair thinning. Vitamin D deficiency is common in people with MS and is associated with MS risk and disease activity in observational studies, though the evidence that vitamin D deficiency directly causes hair loss is limited and should not be overstated. Similarly, while zinc and B vitamin deficiencies have been associated with hair changes in cases of frank deficiency, the evidence for a direct causal role in hair loss is weak in the general population; testing and supplementation should only be considered when there is a clinical indication, not routinely.

Co-existing autoimmune conditions deserve special mention. Both autoimmune thyroid disease and alopecia areata are more prevalent in people with autoimmune conditions and require separate investigation and management if suspected.

Corticosteroids used to treat MS relapses (such as high-dose methylprednisolone) are not typically associated with hair loss; alopecia is listed as an uncommon or rare effect in prescribing information. If you notice hair changes during or after a course of steroids, mention this to your clinical team, but this is unlikely to be the primary cause of significant shedding.

When to Speak to Your GP or MS Nurse

Seek advice if you notice sudden shedding after a new medication, patchy hair loss, hair loss with thyroid symptoms, or thinning persisting beyond six months. First-line investigations include full blood count, ferritin, and thyroid function tests.

Hair loss can feel distressing, particularly when managing a complex condition such as MS. Knowing when to seek advice is important for both your physical health and emotional wellbeing.

Contact your GP or MS nurse if you notice:

• Sudden or significant hair shedding that begins after starting a new medication

• Patchy hair loss, which may suggest alopecia areata or another underlying condition

• Hair loss accompanied by other new symptoms such as fatigue, weight changes, feeling cold, or palpitations — which could indicate thyroid dysfunction

• Hair thinning that persists beyond six months without an obvious cause

• Signs of scalp inflammation, redness, scaling, or pain — these may suggest scarring alopecia and warrant prompt dermatology review

• Significant distress or impact on your quality of life

Your GP may arrange blood tests to investigate potential underlying causes. In line with UK primary care guidance (NICE CKS: Alopecia), first-line investigations typically include:

• Full blood count (to check for anaemia)

• Ferritin and iron studies

• Thyroid function tests (TFTs)

Further tests — such as vitamin B12, vitamin D, zinc, or coeliac serology — may be considered selectively based on your clinical history, dietary intake, or identified risk factors, rather than as a routine panel.

If a medication side effect is suspected, your MS nurse or neurologist should be involved before making any changes to your DMT regimen. NICE NG220 emphasises shared decision-making in MS management, and any concerns about treatment tolerability should be discussed openly with your clinical team. A referral to a dermatologist may be appropriate if the cause remains unclear, if alopecia areata is suspected, or if there are features suggesting scarring alopecia.

Managing Hair Loss Alongside an MS Diagnosis

Addressing confirmed nutritional deficiencies, gentle hair care, stress management, and discussing DMT tolerability with your neurologist are the key management steps. Topical minoxidil is licensed only for androgenetic alopecia and is off-label for other causes.

Managing hair loss when you are already navigating an MS diagnosis requires a practical, compassionate, and evidence-informed approach. In many cases, hair loss associated with MS-related factors is manageable and often reversible once the underlying cause is identified and addressed.

Practical steps that may help include:

• Addressing confirmed nutritional deficiencies: If blood tests reveal low ferritin or other deficiencies, supplementation under medical guidance can support hair regrowth over several months. Avoid high-dose supplementation without a confirmed deficiency and clinician advice, as this carries its own risks

• Gentle hair care: Avoiding excessive heat styling, tight hairstyles, and harsh chemical treatments can reduce additional mechanical stress on fragile hair

• Scalp health: Using mild, sulphate-free shampoos and maintaining a healthy scalp environment may support follicle health

• Stress management: Techniques such as mindfulness, gentle exercise (adapted for MS-related limitations), and psychological support can help reduce the impact of stress-related shedding

For hair loss directly linked to a DMT, your neurologist may consider whether an alternative therapy with a different side-effect profile is appropriate, always balancing this against disease control needs.

Topical minoxidil is a licensed treatment for androgenetic alopecia (pattern hair loss) in the UK. Its use for other causes of hair loss — such as telogen effluvium — is off-label and should only be considered under the guidance of a GP or dermatologist. Key cautions include: it should not be used during pregnancy or breastfeeding; it may cause scalp irritation; and an initial temporary increase in shedding can occur when first starting treatment. Discuss suitability with a clinician before use (BNF: Minoxidil topical).

Emotional support is equally important. Organisations such as the MS Society, Alopecia UK, and the British Association of Dermatologists (BAD) offer resources and peer support for people experiencing hair loss alongside chronic illness. The NHS hair loss (alopecia) pages also provide reliable self-care guidance. Remember that hair loss, while distressing, does not reflect the progression of your MS — and with the right support, many people find effective ways to manage it.

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